NDT Advance Access originally published online on November 19, 2007
Nephrology Dialysis Transplantation 2008 23(4):1436-1441; doi:10.1093/ndt/gfm762
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The combined effect of pre-transplant triglyceride levels and the type of calcineurin inhibitor in predicting the risk of new onset diabetes after renal transplantation
1 Nephrology Section and Research Unit, Hospital Universitario de Canarias, Spain 2 Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain 3 Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain 4 Hospital Insular, Las Palmas de Gran Canaria, Spain 5 Hospital General de Lanzarote, Puerto del Rosario, Lanzarote, Spain 6 Instituto de Investigación Nefrológica Reina, Sofía, Spain 7 University of La Laguna, La Laguna, Spain
Armando Torres, Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320 La Laguna, Tenerife, Spain. Tel: +34-922678380; Email: atorres{at}ull.es
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Abstract |
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Background. Insulin resistance precedes overt diabetes in the general population and hypertriglyceridemia is a reliable marker of the disorder. Thus, patients in the waiting list with hypertriglyceridemia may be at risk for new-onset diabetes after transplantation (NODAT).
Objectives. We investigate whether pre-transplant triglyceride (TG) levels are a risk factor for NODAT and whether they exert a combined effect with the type of calcineurin inhibitor (CNI).
Methods. We analysed 314 consecutive non-diabetic recipients [215 cyclosporine A (CsA); 99 tacrolimus (Tacro)] transplanted between 1999 and 2003 with a mean follow-up of 34 months. Outcome was NODAT defined by ADA criteria.
Results. NODAT developed in 81 recipients (25.8%). Multivariate analysis which included a propensity score for factors determining CNI allocation showed that age (OR: 1.06; 95% CI: 1.03–1.09), pre-transplant BMI (OR: 1.1; 95% CI: 1.02–1.17),TG levels (OR: 1.3 per 50 mg/dl increment, 95% CI: 1.07–1.6) and treated acute rejection (OR: 4.8, 95% CI: 3–11), but not the type of CNI, were independent risk factors for NODAT. A significant interaction between pre-transplant TG and type of CNI was observed. Using CsA as the reference, the combination of Tacro plus pre-transplant hypertriglyceridemia (
200 mg/dl) showed an OR of 3.26 (1.4–7.8) to develop NODAT, contrasting with an OR of 0.75 (0.34–1.6) in Tacro recipients with pre-transplant TG levels <200 mg/dl.
Conclusion. Pre-transplant hypertriglyceridemia was a risk factor for NODAT only in recipients treated with Tacro; it highlights the importance of pre-transplant insulin resistance in the pathogenesis of NODAT.
Keywords: insulin resistance; NODAT; tacrolimus
Received for publication: 22. 5.07
Accepted in revised form: 20. 9.07
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